About this role
Who are we?
Sanlam Developing Markets [SDM] (a wholly-owned subsidiary of Sanlam Life Limited) is one of the top financial services providers in the South African entry-level and emerging middle market. It aims to understand the unique requirements of clients and offers a wide range of simple and affordable financial solutions that cover needs such as funeral insurance, savings for education, life cover and personal accident plans. In terms of the Sanlam Group Governance Policy, SDM is managed by the SA Retail Mass cluster, which is part of the Sanlam Life and Savings cluster within the Sanlam Group. The cluster focusses on retail products, as well as group schemes. Purpose of the Role To lead claims specialists managing varied portfolios, overseeing quality, productivity, fraud control, and customer outcomes in line with governance requirements.
- Overview of Role Responsibilities (Level 1-13) Insurance Claims Administration - Level 5 - Application Review and analyze assigned insurance claims in line with the organization's standard claims procedures and customer service standards.
- Engage loss adjusters and/or subject-matter experts where appropriate, authorize claims within delegated authority, and refer complex or unresolved issues to senior colleagues.
- Insurance Claims Evaluation - Level 5 - Application Interview and/or visit claimants to evaluate the extent of liability and the value of insured losses in line with policy coverage.
- Adjust losses and negotiate settlement within delegated authority limits, referring complex or disputed claims to senior colleagues for resolution.
- Leadership and Direction - Level 5 - Application Explain the local action plan, to support team members in their understanding of what needs to be done, and how this relates to the broader business plan and the organization's strategy, mission, and vision; motivate people to achieve local business goals.
- Performance Management - Level 5 - Application Respond to personal objectives and use performance management systems to improve personal performance; or monitor the performance of the team, allocate work and review completion, take appropriate corrective action to ensure timeliness and quality, and contribute to formal individual performance management and appraisal.
- Organizational Capability Building - Level 5 - Application Provide coaching to team members to develop their skills.
- Operational Compliance - Level 5 - Application Identify, within the team, instances of noncompliance with the organization's policies and procedures and/or relevant regulatory codes and codes of conduct, reporting these instances and escalating issues as appropriate.
- Required Skills Policy and procedures - Fully Competent Works with full competence to monitor, interpret and understand policies and procedures and ensure their alignment with organizational strategies and work objectives.
- Typically works without supervision and may provide technical guidance.
- Claims Management - Fully Competent Works with full competence to handle individual and portfolios of claims cost effectively, minimizing claims leakage, and meeting organizational and customer claims service standards.
- Claims Handling - Fully Competent Works with full competence to use and apply processes and procedures for processing claims by an intermediary.
- Claims Settlement - Fully Competent Works with full competence to agree quantum and settle claims, identifying any opportunities for recoveries and its application.
- Claims Notification and Investigation - Fully Competent Works with full competence to use and apply the claims notification process, and validate and investigate claims.
- Verbal Communication - Fully Competent Works with full competence to express ideas, request actions, formulate plans, and policies by means of clear and effective verbal communications.
- General Experience Matric Bachelor’s degree or Diploma in Business Administration, Management, or a related field (advantageous) 3+ years’ experience in a claims environment, with exposure to leadership or supervisory responsibilities (preferred).
Proficiency in MS Word and Excel (intermediate level essential). Strong computer literacy and ability to adapt to new systems. Managerial Experience Experience of general supervision of employees (Minimum 3 year) in a claims environment Education Undergraduate Degree / Honours Tertiary Degree Required Behavioural Competencies Instils Trust Manages Complexity Drives Results Cultivates Innovation Directs Work Ensures Accountability The Sanlam Group is committed to achieving transformation and embraces diversity. This commitment is what drives us to achieve a diverse, inclusive and equitable workplace as we believe that these are key components to ensuring a thriving and sustainable business in South Africa. The Group's Employment Equity plan and targets will be considered as part of the selection process.